Int J Stomatol

Inter J Stomatol ›› 2019, Vol. 46 ›› Issue (2): 135-141.doi: 10.7518/gjkq.2019010

• Systematic Reviews • Previous Articles     Next Articles

Xenogeneic collagen matrix versus autogenous connective tissue graft in periodontal soft tissue augmentation: a systematic review and Meta-analysis

Fangfang Fang1,Yaqin Chang1,Yingchun Dong2,Shasha Qin3,Bin Chen1()   

  1. 1. Dept. of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
    2.Dept. of Anesthesiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
    3.Dept. of Chronic Non-communicable Diseases Prevention and Control, Xi’an Center for Disease Control and Prevention, Xi’an 710054, China)
  • Received:2018-07-22 Revised:2018-12-15 Online:2019-03-01 Published:2019-03-15
  • Contact: Bin Chen E-mail:361734128@qq.com
  • Supported by:
    This study was supported by Nanjing Medical Science and Technique Development Foundation(QRX17176);Jiangsu Provincial Medical Youth Talent, the Project of Invigorating Health Care though Science, Technology and Education(QNRC2016117)

RichHTML

25

PDF (PC)

418

Abstract:

Objective In this systematic review, we aimed to compare the effectiveness of xenogeneic collagen matrix (XCM) and autogenous connective tissue graft (CTG) in periodontal soft tissue augmentation. Methods We searched randomized controlled clinical studies published from 2000 to July 2018 in electronic databases, including PubMed, EMbase, Cochrane, Web of Science, CNKI, CBM, Wanfang database, and VIP. RevMan5.3 software was used to analyze and compare the width of keratinized tissue (KTW), thickness of keratinized tissue (TKT), average root coverage (ARC), and surgery time. Results A total of 10 randomized controlled trials were included. There was no difference between XCM and CTG (P>0.05) in terms of the augmentation of KTW and ARC at the follow time of 6 months, XCM was less effective than CTG at 12 months. CTG had a higher augmentation in TKT compared with XCM (P<0.05) at 12 months. XCM needed shorter operation time than CTG (P<0.05). Conclusion The limited evidence showed XCM had similar augmentation of KTW and ARC. There was insufficient evidence to prove that CTG was more effective in the augmentation of TKT than XCM and that XCM required shorter surgery time. Long-term, multicenter, and prospective randomized controlled clinical studies with large sample sizes are necessary to further validate the problem.

Key words: xenogeneic collagen matrix, connective tissue graft, soft tissue augmentation

CLC Number: 

  • R781.4

TrendMD: 

Tab 1

Characteristics of included studies"

研究 试验设计 数量（患者/位点） 年龄/岁 材料（试验组/ 对照组） 牙体类型 颌位 观察指标 研究时
长/月		 测量时间点/月
Sanz等[12] RCT（平行对照） 20/20 T：64.3
C：59.2		 XCM（MG）/ CTG 天然牙/种植体 NR KTW、手术时间 6 0、1、3、6
McGuire等[13] RCT（平行对照） 25/50 43.7±12.2 XCM（MG）/ CTG 天然牙 上下颌 KTW、ARC 12 0、1、2、3、6、12
Cardaropoli等[14] RCT（平行对照） 18/22 41.39±10.02 XCM（MG）/ CTG 天然牙 T：上颌7下颌4 C：上颌11 KTW、TKT、ARC 12 0、1、3、6、12
Lorenzo等[15] RCT（平行对照） 24/24 T：62±8.7
C：63±7.9		 XCM（MG）/ CTG 种植体 T：上颌1下颌11 C：下颌12 KTW、手术时间 6 0、1、3、6
Aroca等[16] RCT（口内分组对照） 22/156 >18 XCM（MG）/ CTG 天然牙 上下颌 KTW、TKT、ARC、手术时间 12 0、1、3、6、12
Cie?lik-Wege-mund等[17] RCT（平行对照） 28/106 20~50 XCM（MD）/ CTG 天然牙 上下颌 KTW、ARC 6 0、3、6
Cairo等[18] RCT（平行对照） 60/60 T：50.3±12.4
C：48.3±11.8		 XCM（MG）/ CTG 种植体 上下颌 KTW、TKT、手术时间 6 0、1、3、6
Thoma等[11] RCT 20/20 T：64.3
C：59.2		 XCM（MG）/ CTG 种植体 T：上颌10
C：上颌 9下颌1		 TKT、手术时间 3 0、1、3
Puzio等[19] RCT 25/30 T：43.8±13.2
C：42.7±19.1		 XCM（MG）/ CTG 种植体 T：上颌12下颌3
C：上颌14下颌1		 TKT 12 0、3、12
Tatarakis等[20] RCT 8/8 T：38.75±11.70
C：37.75±18.17		 XCM（MG）/ CTG 天然牙 上颌 KTW 6 0、2、6

Tab 2

Risk of bias of included studies"

纳入研究 随机序列生成 分配隐藏 实施盲法 结果测量盲法 失访偏倚 报告偏倚 其他偏倚
Sanz等[12] 恰当 恰当 恰当 不清楚 不清楚 不清楚 恰当
McGuire等[13] 恰当 不清楚 恰当 恰当 恰当 恰当 恰当
Cardaropoli等[14] 恰当 不清楚 恰当 恰当 恰当 恰当 恰当
Lorenzo等[15] 恰当 恰当 恰当 恰当 恰当 不清楚 恰当
Aroca等[16] 恰当 恰当 恰当 恰当 恰当 恰当 恰当
Cie?lik-Wegemund等[17] 恰当 恰当 恰当 不恰当 恰当 恰当 恰当
Cairo等[18] 恰当 恰当 恰当 恰当 恰当 恰当 恰当
Thoma等[11] 恰当 恰当 恰当 恰当 不恰当 不清楚 恰当
Puzio等[19] 恰当 恰当 不清楚 恰当 恰当 恰当 恰当
Tatarakis等[20] 恰当 恰当 恰当 不清楚 恰当 恰当 恰当

Fig 1

Meta-analysis of the increase in KTW"

Fig 2

Meta-analysis of the increase in TKT"

Fig 3

Meta-analysis of ARC"

[1] Cairo F, Cortellini P, Tonetti M , et al. Coronally ad-vanced flap with and without connective tissue graft for the treatment of single maxillary gingival reces-sion with loss of inter-dental attachment. A randomized controlled clinical trial[J]. J Clin Periodontol, 2012,39(8):760-768.
doi: 10.1111/j.1600-051X.2012.01903.x pmid: 22639845
[2] Soileau KM, Brannon RB . A histologic evaluation of various stages of palatal healing following subepi-thelial connective tissue grafting procedures: a com-parison of eight cases[J]. J Periodontol, 2006,77(7):1267-1273.
doi: 10.1902/jop.2006.050129 pmid: 16805692
[3] Zucchelli G, Mounssif I . Periodontal plastic surgery[J]. Periodontol 2000, 2015,68(1):333-368.
doi: 10.1111/prd.12059
[4] Nevins M, Nevins ML, Kim SW , et al. The use of mucograft collagen matrix to augment the zone of keratinized tissue around teeth: a pilot study[J]. Int J Periodontics Restorative Dent, 2011,31(4):367-373.
doi: 10.4012/dmj.2011-028 pmid: 21837302
[5] Schneider D, Grunder U, Ender A , et al. Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study[J]. Clin Oral Implants Res, 2011,22(1):28-37.
doi: 10.1111/j.1600-0501.2010.01987.x pmid: 21039891
[6] Atieh MA, Alsabeeha N, Tawse-Smith A , et al. Xeno- geneic collagen matrix for periodontal plastic surgery procedures: a systematic review and meta-analysis[J]. J Periodontal Res, 2016,51(4):438-452.
doi: 10.1111/jre.12333 pmid: 26547393
[7] Maiorana C, Pivetti L, Signorino F , et al. The efficacy of a porcine collagen matrix in keratinized tissue aug- mentation: a 5-year follow-up study[J]. Int J Implant Dent, 2018,4(1):1.
doi: 10.1186/s40729-017-0113-3 pmid: 5760488
[8] Cairo F, Pagliaro U, Buti J , et al. Root coverage pro-cedures improve patient aesthetics. A systematic re- view and Bayesian network meta-analysis[J]. J Clin Periodontol, 2016,43(11):965-975.
doi: 10.1111/jcpe.12603 pmid: 27454460
[9] Bertl K, Melchard M, Pandis N , et al. Soft tissue substitutes in non-root coverage procedures: a syste- matic review and meta-analysis[J]. Clin Oral Investig, 2017,21(2):505-518.
doi: 10.1007/s00784-016-2044-4 pmid: 5318480
[10] Amine K, El Amrani Y, Chemlali S , et al. Alternatives to connective tissue graft in the treatment of localized gingival recessions: a systematic review[J]. J Stomatol Oral Maxillofac Surg, 2018,119(1):25-32.
doi: 10.1016/j.jormas.2017.09.005 pmid: 28893718
[11] Thoma DS, Zeltner M, Hilbe M , et al. Randomized controlled clinical study evaluating effectiveness and safety of a volume-stable collagen matrix compared to autogenous connective tissue grafts for soft tissue augmentation at implant sites[J]. J Clin Periodontol, 2016,43(10):874-885.
doi: 10.1111/jcpe.12588 pmid: 27310522
[12] Sanz M, Lorenzo R, Aranda JJ , et al. Clinical evalua- tion of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial[J]. J Clin Periodontol, 2009,36(10):868-876.
doi: 10.1111/cpe.2009.36.issue-10
[13] McGuire MK, Scheyer ET . Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects[J]. J Periodontol, 2010,81(8):1108-1117.
doi: 10.1902/jop.2010.090698 pmid: 20350159
[14] Cardaropoli D, Tamagnone L, Roffredo A , et al. Treat- ment of gingival recession defects using coronally advanced flap with a porcine collagen matrix compared to coronally advanced flap with connective tissue graft: a randomized controlled clinical trial[J]. J Periodontol, 2012,83(3):321-328.
doi: 10.1902/jop.2011.110215 pmid: 21721988
[15] Lorenzo R, García V, Orsini M , et al. Clinical efficacy of a xenogeneic collagen matrix in augmenting kera-tinized mucosa around implants: a randomized con-trolled prospective clinical trial[J]. Clin Oral Implants Res, 2012,23(3):316-324.
doi: 10.1111/j.1600-0501.2011.02260.x pmid: 22092380
[16] Aroca S, Molnár B, Windisch P , et al. Treatment of multiple adjacent Miller classⅠand Ⅱgingival rece-ssions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled cli- nical trial[J]. J Clin Periodontol, 2013,40(7):713-720.
doi: 10.1111/jcpe.12112 pmid: 23627374
[17] Cieślik-Wegemund M, Wierucka-Młynarczyk B, Tanasiewicz M , et al. Tunnel technique with collagen matrix compared with connective tissue graft for treat- ment of periodontal recession: a randomized clinical trial[J]. J Periodontol, 2016,87(12):1436-1443.
doi: 10.1902/jop.2016.150676
[18] Cairo F, Barbato L, Tonelli P , et al. Xenogeneic colla- gen matrix versus connective tissue graft for buccal soft tissue augmentation at implant site. A randomized, controlled clinical trial[J]. J Clin Periodontol, 2017,44(7):769-776.
doi: 10.1111/jcpe.12750 pmid: 28548210
[19] Puzio M, Błaszczyszyn A, Hadzik J , et al. Ultrasound assessment of soft tissue augmentation around im- plants in the aesthetic zone using a connective tissue graft and xenogeneic collagen matrix—1-year rando-mised follow-up[J]. Ann Anat, 2018,217:129-141.
doi: 10.1016/j.aanat.2017.11.003 pmid: 29248711
[20] Tatarakis N, Gkranias N, Darbar U , et al. Blood flow changes using a 3D xenogeneic collagen matrix or a subepithelial connective tissue graft for root coverage procedures: a pilot study[J]. Clin Oral Investig, 2018,22(4):1697-1705.
doi: 10.1007/s00784-017-2261-5 pmid: 29080078
[21] Zeltner M, Jung RE, Hämmerle CH , et al. Randomized controlled clinical study comparing a volume-stable collagen matrix to autogenous connective tissue grafts for soft tissue augmentation at implant sites: linear volumetric soft tissue changes up to 3 months[J]. J Clin Periodontol, 2017,44(4):446-453.
doi: 10.1111/jcpe.12697 pmid: 28107560
[22] Buti J, Baccini M, Nieri M , et al. Bayesian network meta-analysis of root coverage procedures: ranking efficacy and identification of best treatment[J]. J Clin Periodontol, 2013,40(4):372-386.
doi: 10.1111/jcpe.12028 pmid: 23346965
[23] Griffin TJ, Cheung WS, Zavras AI , et al. Postopera-tive complications following gingival augmentation procedures[J]. J Periodontol, 2006,77(12):2070-2079.
doi: 10.1902/jop.2006.050296 pmid: 17209793
[24] Cairo F, Barbato L, Tonelli P , et al. Xenogeneic col-lagen matrix versus connective tissue graft for buccal soft tissue augmentation at implant site. A randomized, controlled clinical trial[J]. J Clin Periodontol, 2017,44(7):769-776.
doi: 10.1111/jcpe.12750 pmid: 28548210
[1] Liu Jiamei,Wu Yanmin. Application of periodontal plastic surgery in the preservation and reconstruction of gingival papilla [J]. Int J Stomatol, 2020, 47(3): 318-327.
[2] Lingling Liu,Shutai Liu. Measurement methods and relevant factors of the soft tissue thickness in the palatal masticatory mucosa of maxillary [J]. Inter J Stomatol, 2019, 46(2): 234-237.
[3] Tingting Zhang,Juanjuan Zong. Research progress on connective tissue graft [J]. Inter J Stomatol, 2019, 46(1): 89-93.
[4] Wan Shuangquan, Deng Feilong. Clinical applications of subepithelial connective tissue grafting in soft tissue deficiencies of dental implantation [J]. Inter J Stomatol, 2018, 45(1): 68-73.
[5] Man Yi, Wu Qingqing, Gong Ting, Gong Ping. A new surgical and prosthetic protocol for dental implant treatment in the aesthetic area [J]. Inter J Stomatol, 2015, 42(4): 373-383.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[7] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 458 -460 .
[8] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 452 -454 .
[9] . [J]. Inter J Stomatol, 2008, 35(S1): .
[10] . [J]. Inter J Stomatol, 2008, 35(S1): .